Orchard Park Fire District EMS

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Financial Hardship policy

 

Orchard Park Fire District EMS, Inc. hereinafter referred to as OPFDEMS, Inc. has established this Financial Hardship policy in order to maintain consistency in assisting uninsured and indigent patients who request a reduction or waiver of certain ambulance charges.  

Professional Ambulance Billing LLC will manage all requests for financial hardship for OPFDEMS, INC.  PAB will take into account the overall financial circumstances of the applicant and apply this policy consistently. 

If approved, PAB may elect to reduce or waive certain amounts which are due from our patients who can successfully demonstrate that paying ambulance fees would cause significant financial hardship. 

Financial Hardship Criteria:

PAB will take into account a range of factors when deciding whether the full payment of the ambulance charges will cause the applicant financial hardship. In making the decision whether to waive the fee, PAB will compare the amount earned, living expenses, assets and debts.  Written verification, when available, may be required to substantiate and verify information contained in the financial hardship application. 

PAB uses a combination of the current year’s federal poverty guidelines to help in determining if an applicant qualifies for a financial hardship waiver. 

In applying these guidelines, PAB will also consider and take into account any other income and expenses including money earned in the entire household. Income and employment status verification may be required; including tax returns; check stubs, etc. 

  1. Whether payment of the ambulance charges will affect the applicant’s ability to pay for the following living expenses:
    • food and clothes;
    • rent or mortgage payments;
    • any other basic needs; or
    • any special needs (for a serious illness or disability)
  1. Whether the applicant owns any assets, such as a car or house. Assets also include:
    •   investments;
    • money in the bank;
    • cash on hand for short term expenses; and 
    • money designated for special needs. 
  1. Whether the applicant has any debts.

Applicants can download and complete a Financial Hardship Application Form HERE. The form is a pdf document.  If you like, you can also obtain the form by calling (716)204-3350 or by visiting the OPFDEMS, INC. Business office at 3920 Taylor Rd Orchard Park, NY 14127, or PAB Offices at 5530 Sheridan Drive Suite 3B Williamsville, NY 14221 during normal business hours.  Forms can also be requested, through submission of a written request, to the above listed addresses for the PAB or OPFDEMS, INC. Business Offices. 

If applying in person, please be prepared to offer written verification of the necessary information about your financial circumstances. If you have difficulty performing any of these tasks, please contact OPFDEMS, INC. at (716) 662-2619. Applicants are required to return the completed forms and submit all required documentation to PAB.

Required Information:

PAB requires independent information to support claims of financial hardship including verification of expenses and income. The information submitted will be treated confidentially and will only be reviewed by PAB administrative staff involved in processing requests for waiver of ambulance charges.

 

Number of Persons in Family or Household

48 Contiguous States and D.C.

200% Threshold Established by OPFDEMS,INC.

1

$11,770

$23,540

2

$15,930

$31,860

3

$20,090

$40,180

4

$24,250

$48,500

5

$28,410

$56,820

6

$32,570

$65,100

7

$36,730

$73,480

8

$40,890

$81,780

For each additional person,

in families exceeding eight members,

add >>>>>>

$4,160

$8,320